Contract Pharmacy Details

HOOK-SUPERX, L.L.C.
CHC12846-03 Purdue University

Covered Entity Details

Entity Name

Purdue University

Subdivision Name

Family Health Clinic of Monon

Type

HRSA-Funded Health Center

340B ID

CHC12846-03

Entity Address

692 E Broadway St
Monon, IN 47959-8191

Grant Number

H80CS12846

Participating Start Date

1/1/2024

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

HOOK-SUPERX, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06674
505 WEST MAIN STREET
DELPHI, IN 46923

Pharmacy Comments

Contract Details

Approval Date

1/16/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sherri Gehlhausen, Director of Revenue Cycle
(765) 564-3016

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/16/2024

340B Drug Pricing Program Database